SNAKE RIVER DERMATOLOGY, PA (NPI# 1528263670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528263670 |
| Entity Type | Organization |
| Organization Name | SNAKE RIVER DERMATOLOGY, PA |
| Other Organization Name | GERALD G. OVERLY, MD, PA |
| Practice Address |
1611 N Whitley Dr #7 Fruitland ID 83619 |
| Mailing Address |
1611 N Whitley Dr Suite #7 Fruitland ID 83619 |
| Practice Telephone | 2084525999 |
| Practice Fax Number | 2084524499 |
| Mailing Telephone | 2084525999 |
| Mailing Fax Number | 2084524499 |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2013-02-04 |
| Authorized Official Name | DR. BROCK ARBEN ANDERSEN II (PRINCIPAL OFFICER) |
| Authorized Official Telephone | 2084525999 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | M3809 | ID | Allopathic & Osteopathic Physicians |
| Y | 207N00000X | Dermatology | M-11462 | ID | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Gerald G. Overly, MD, PA | Former Legal Business Name - Organization |
| Street Address |
1611 N WHITLEY DR #7 |
| City | FRUITLAND |
| State | ID |
| Zip Code | 83619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851766976 | Cody Brown | Counselor | 1611 N Whitley Dr, Fruitland, ID 83619-2177 | 2015-12-01 |
| 1275956880 | Ron Vanausdal | Social Worker | 1611 N Whitley Dr, Fruitland, ID 83619-2177 | 2014-02-03 |
| 1073853529 | Therapy Connection | Physical Therapist | 1611 N Whitley Dr, Unit 1a, Fruitland, ID 83619-2177 | 2013-02-20 |
| 1811255755 | Lana M Usilton | Nutritionist | 1611 N Whitley Dr, Ste 1a, Fruitland, ID 83619-2177 | 2012-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992322382 | Dallin Scott Wilkes | Physical Therapist | 2175 N Whitley Dr., Fruitland, ID 83619 | 2020-07-01 |
| 1659925113 | Treasure Valley Classical Academy | Local Education Agency (LEA) | 500 Sw 3rd Street, Fruitland, ID 83619 | 2019-08-01 |
| 1083146559 | Total Renal Care, Inc. | Clinic/Center | 815 Nw 13th St, Fruitland, ID 83619 | 2017-04-03 |
| 1154563948 | Becky Jean Wolery | Social Worker | 910 Nw 16th St Ste 101, Fruitland, ID 83619 | 2009-03-25 |
| 1740426196 | John Wesley Linhart | Physical Therapist | 1116 Nw 16th Street, Fruitland, ID 83619 | 2009-01-06 |
| 1568591204 | John Linton Close | Registered Nurse | 1509 N Whitley Drive, Suite 5, Fruitland, ID 83619 | 2007-03-05 |
| 1629110671 | Payette School Dist #373 | Local Education Agency (LEA) | 303 Sw 3rd Street, Fruitland, ID 83619 | 2007-02-13 |
| 1912075839 | William Frederick Martsch | Dentist | 315 N. Whitley, Fruitland, ID 83619 | 2006-11-30 |
| 1992880132 | Ryan David Hillam | Dentist | 1820 N.whitley Drive, Fruitland, ID 83619 | 2006-10-26 |
| 1285723460 | Kurt E Kracaw | Family Medicine | 910 Nw 16th St, Ste 101, Fruitland, ID 83619 | 2006-10-12 |
| Find all providers in zip 83619 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902843485 | Ct Derm PC | Dermatology | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2006-06-01 |
| 1558349852 | Brock Arben Andersen | Dermatology | 2101 N Whitley Dr, Fruitland, ID 83619-2132 | 2006-01-06 |
| 1083653489 | Carl R Thornfeldt | Dermatology | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356942437 | Stoddard & Bingham Medical of Rexburg Pllc | Dermatology | 859 S Yellowstone Hwy Ste 3302, Rexburg, ID 83440-6200 | 2020-11-04 |
| 1508345091 | Integrated Dermatology of Idaho LLC | Dermatology | 388 E Parkcenter Blvd, Boise, ID 83706-3942 | 2018-08-07 |
| 1306209556 | Garrett Coman | Dermatology | St. Luke's Dermatology, 191 5th Street West, Ketchum, ID 83340 | 2016-04-04 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1104220797 | Boise Skin Clinic Pllc | Dermatology | 1636 S Hadley Ave, Boise, ID 83709-2684 | 2014-10-10 |
| 1164834073 | Colby Bingham | Dermatology | 1344 Hiland Ave Ste D, Burley, ID 83318-1564 | 2014-05-27 |
| 1699194530 | Dustin Larsen | Dermatology | 2199 N Merrit Crk Loop, Coeur D Alene, ID 83814-4949 | 2014-04-08 |
| 1265795660 | Richard Scott Thomas | Dermatology | 4664 N Penngrove Way Ste 100, Meridian, ID 83646-7442 | 2012-06-20 |
| 1316216369 | Ashley Anne Hamstra | Dermatology | 421 E Lakeside Ave Ste 105, Coeur D Alene, ID 83814-2848 | 2011-12-20 |
| 1487899365 | Jaclyn Golus Mentzer | Dermatology | 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706 | 2008-12-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.